Provider Demographics
NPI:1356443675
Name:MORIARTY, PATRICK M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD.
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6000
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 3008
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6057
Practice Address - Fax:913-588-4074
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25361207R00000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21063013OtherBCBS KC
MO207880808Medicaid
KS626590OtherFIRSTGUARD
KS100163790AMedicaid
KS100163790AMedicaid
KS626590OtherFIRSTGUARD
KS110121110Medicare ID - Type UnspecifiedRAILROAD MEDICARE